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Neuropeptides Dec 2018This review analyzed the published studies on the effects of thermal injury on gastrointestinal motility and mucosal damage. Our strategy was to integrate all available... (Review)
Review
This review analyzed the published studies on the effects of thermal injury on gastrointestinal motility and mucosal damage. Our strategy was to integrate all available evidence to provide a complete review on the prokinetic properties of variable reagents and the potential clinical treatment of mucosal damage and gastrointestinal dysmotility after thermal injury. We classified the studies into two major groups: studies on gastrointestinal dysmotility and studies on mucosal damage. We also subclassified the studies into 3 parts: stomach, small intestine, and colon. This review shows evidence that ghrelin can recover burn-induced delay in gastric emptying and small intestinal transit, and can protect the gastric mucosa from burn-induced injury. Oxytocin and β-glucan reduced the serum inflammatory mediators, and histological change and mucosal damage indicators, but did not show evidence of having the ability to recover gastrointestinal motility. Using a combination of different reagents to protect the gastrointestinal mucosa against damage and to recover gastrointestinal motility is an alternative treatment for thermal injury.
Topics: Animals; Burns; Gastric Emptying; Gastric Mucosa; Gastrointestinal Motility
PubMed: 30269923
DOI: 10.1016/j.npep.2018.09.004 -
Scandinavian Journal of Gastroenterology Jan 2019Idiopathic gastroparesis is a gastric motility disorder characterized by chronic upper gastrointestinal symptoms and delayed gastric emptying without an identifiable... (Review)
Review
OBJECTIVES
Idiopathic gastroparesis is a gastric motility disorder characterized by chronic upper gastrointestinal symptoms and delayed gastric emptying without an identifiable underlying condition. This review summarizes recent understanding of the pathophysiology and treatment of idiopathic gastroparesis.
MATERIALS AND METHODS
Structured literature search in the PubMed, Embase and ClinicalTrials.gov databases.
RESULTS
Idiopathic gastroparesis involves several alterations in gastric motility and sensation, including delayed gastric emptying, altered myoelectrical activity, impaired fundic accommodation, visceral hypersensitivity and disturbances in antropyloroduodenal motility and coordination. Multiple cellular changes have been identified, including depletion of interstitial cells of Cajal (ICC) and enteric nerves, as well as stromal fibrosis. The underlying cause of these changes is not fully understood but may be an immune imbalance, including loss of anti-inflammatory heme-oxygenase-1 positive (HO-1) macrophages. There is currently no causal therapy for idiopathic gastroparesis. The treatment ladder consists of dietary measures, prokinetic and antiemetic medications, and varying surgical or endoscopic interventions, including promising pyloric therapies. There are ongoing trials with several novel medications, raising hopes for future treatment.
CONCLUSIONS
Patients with idiopathic gastroparesis present several pathophysiological alterations in the stomach, where depletion of ICC is of special importance. Treatment is currently focused on alleviating symptoms through dietary adjustments, medication or surgical or endoscopic interventions.
Topics: Combined Modality Therapy; Diet Therapy; Electric Stimulation Therapy; Gastric Emptying; Gastrointestinal Agents; Gastroparesis; Humans; Interstitial Cells of Cajal; Randomized Controlled Trials as Topic
PubMed: 30638082
DOI: 10.1080/00365521.2018.1558280 -
Current Diabetes Reviews 2018Gastroparesis (a complication of both type 1 and type 2 diabetes mellitus) is delayed gastric emptying in the absence of a mechanical obstruction. Overall prevalence of... (Review)
Review
INTRODUCTION
Gastroparesis (a complication of both type 1 and type 2 diabetes mellitus) is delayed gastric emptying in the absence of a mechanical obstruction. Overall prevalence of Gastroparesis is close to 5 % in type 1 diabetes and 1 % in type 2 diabetes. It is unclear if good glycemic control leads to the delay of development and progression of gastroparesis.
METHODS
Gastric enteric neurons as well as Interstitial Cells of Cajal (ICC) are depleted, truncated and are surrounded by immune infiltrates composed of macrophages. There are associated vagal nerve innervation abnormalities, smooth muscle and Fibroblast Like Cell (FLC) dysfunctions. There is s decrease in HO-1 macrophages and increase in proinflammatory macrophages. Gastric electrical rhythm abnormalities and channelopathies have been implicated in the pathology of gastrointestinal diseases.
RESULTS
In patients with diabetes, the most common clinical symptoms include abdominal bloating and pain. Nuclear Medicine Gastric Emptying Scintigraphy (NMGES) is considered the gold standard for evaluation of gastroparesis. Conventional imaging techniques such as fluoroscopic evaluation of gastric emptying can only evaluate the presence or absence of an obstruction. Historically, solid gastric emptying has been the method for evaluation although recent data suggests that liquid gastric emptying may be altered without solid gastric emptying abnormality. It is paramount that a radiotracer for evaluating gastric emptying be tightly bound to ingested food (solid). The most frequent radiotracer used is Tc99msulfur colloid bound to egg whites. In an effort to standardize normal values across institutions, a consensus recommendation published in 2008 called for a 4- hour study utilizing a standardized meal.
CONCLUSION
Nuclear Medicine Gastric Emptying Scintigraphy (NMGES) is the test of choice for evaluation of diabetic gastroparesis. Standard guidelines have been established for the performance and interpretation of the test.
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Gastric Emptying; Gastroparesis; Humans; Radionuclide Imaging; Stomach
PubMed: 28128051
DOI: 10.2174/1573399813666170126110932 -
Digestive Diseases and Sciences Aug 2022Patients with gastroparesis often consume only small meals due to early satiety.
BACKGROUND
Patients with gastroparesis often consume only small meals due to early satiety.
AIMS
(1) Describe meal eating characteristics of patients with gastroparesis; (2) Relate meal eating characteristics to symptoms, gastric emptying (GE), and body weight.
METHODS
Patients with gastroparesis filled out questionnaires including Patient Assessment of Upper GI Symptoms (PAGI-SYM), and questionnaire about meal habits and body weight. Patients underwent gastric emptying scintigraphy.
RESULTS
Of 192 gastroparesis patients, 93% endorsed early satiety (ES) with severity of 3.7 ± 1.5 (scored from 0-5) and 93% endorsed postprandial fullness (PPF) with severity of 3.9 ± 1.3. Time spent consuming meals averaged 13.6 ± 17.7 min. Main reasons patients stopped eating were fullness (61%), nausea (48%), and abdominal pain (31%). Time spent eating correlated inversely with severity of nausea (r = -0.18, p < 0.05), stomach fullness (r = -0.21, p < 0.01), PPF (r = -0.23, p < 0.01), loss of appetite (r = -0.34, p < 0.01). Postprandial fullness lasted for 316 ± 344 min. Duration of PPF correlated with nausea (r = 0.30, p < 0.01), retching (r = 0.29, p < 0.01), vomiting (r = 0.28, p < 0.01), stomach fullness (r = 0.33, p < 0.01), loss of appetite (r = 0.35, p < 0.01), and constipation (r = 0.27, p < 0.01). Underweight patients had increased inability to finish a normal size meal (p < 0.01), loss of appetite (p < 0.01), and lower abdominal pain/discomfort (p < 0.05). Patients had lost 3.06 ± 10.60 kgs from their baseline weight. Weight loss correlated with nausea (r = 0.26, p < 0.01), ES (r = 0.30, p < 0.01), loss of appetite (r = 0.28, p < 0.01).
CONCLUSIONS
Early satiety and postprandial fullness were common with high severity. The main reasons for meal cessation were early satiety, nausea, and abdominal pain. Body weight and change in body weight were associated with symptoms of gastroparesis.
Topics: Abdominal Pain; Body Weight; Gastric Emptying; Gastroparesis; Humans; Meals; Nausea; Vomiting
PubMed: 34324088
DOI: 10.1007/s10620-021-07190-0 -
Obesity Surgery Jun 2021Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have... (Review)
Review
Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.
Topics: Gastric Balloon; Gastric Emptying; Humans; Obesity, Morbid; Stomach; Treatment Outcome; Weight Loss
PubMed: 33788158
DOI: 10.1007/s11695-021-05352-7 -
Current Gastroenterology Reports Mar 2020This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp). (Review)
Review
PURPOSE OF REVIEW
This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp).
RECENT FINDINGS
Major current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP®) are allowing clinicians better characterization of their patients. In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as G-POEM, may help address refractory Gp. We expect that the 2020 decade will witness exciting developments. Treatments targeting gastrointestinal motility, immunological dysfunction, and inflammatory mediators will be evaluated. We anticipate future studies will be guided by biomarkers correlated with patient outcomes and therapeutic efficacy to establish new paradigms in the management of Gp.
Topics: Biomarkers; Breath Tests; Capsule Endoscopy; Gastric Emptying; Gastrointestinal Motility; Gastroparesis; Humans; Pyloromyotomy
PubMed: 32193707
DOI: 10.1007/s11894-020-00761-7 -
Neurogastroenterology and Motility Aug 2022Gastric emptying (GE) requires precise antropyloroduodenal coordination for effective transpyloric flow, the mechanisms of which are still unclear. We aimed to correlate...
BACKGROUND/OBJECTIVES
Gastric emptying (GE) requires precise antropyloroduodenal coordination for effective transpyloric flow, the mechanisms of which are still unclear. We aimed to correlate gastric antral function assessed by antroduodenal manometry (ADM) with GE scintigraphy (GES) for liquid feeds in children with suspected gastrointestinal dysmotility.
METHODS
Children who underwent both ADM and GES over a five-year period were reviewed. ADM tracings were re-analyzed to assess antral frequency, amplitude, and motility index (MI) pre-prandially and postprandially. Transpyloric propagation (TPP) was defined as antegrade propagated antral activity preceding duodenal phase III of the migrating motor complex (MMC). TPP was defined as "poor" if occurring in <50% of all presented duodenal phases III. For GES, regions of interest over the whole stomach, fundus, and antrum were drawn to calculate GE half-time (GE-T ) and retention rate (RR) in each region at 1 and 2 h.
RESULTS
Forty-seven children (median age: 7.0 years) were included. Twenty-two had PIPO, 14 functional GI disorders, and 11 gastroparesis. Children with poor TPP had longer GE-T (113.0 vs 66.5 min, p = 0.028), higher RR of the whole stomach and fundus at 1 h (79.5% vs 63.5%, p = 0.038; 60.0% vs 41.0%, p = 0.022, respectively) and 2 h (51.0% vs 10.5%, p = 0.005; 36.0% vs 6.5%, p = 0.004, respectively). The pre-prandial antral amplitude of contractions inversely correlated with GE-T , RR of the whole stomach, and fundus at 2 h.
CONCLUSIONS
TPP during phase III of the MMC correlated with gastric emptying of liquid and its assessment on ADM might predict abnormalities in postprandial gastric function.
Topics: Child; Duodenum; Gastric Emptying; Gastrointestinal Motility; Gastroparesis; Humans; Manometry; Myoelectric Complex, Migrating; Pyloric Antrum
PubMed: 35254724
DOI: 10.1111/nmo.14334 -
Journal of Pediatric Gastroenterology... Aug 2022The primary objective was to compare the patient-reported gastrointestinal symptoms profiles of pediatric patients with gastroparesis to matched healthy controls using...
OBJECTIVES
The primary objective was to compare the patient-reported gastrointestinal symptoms profiles of pediatric patients with gastroparesis to matched healthy controls using the Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms Scales. The secondary objectives were to compare pediatric patients with gastroparesis to pediatric patients with gastroparesis-like symptoms and normal gastric emptying and to compare pediatric patients with gastroparesis-like symptoms and normal gastric emptying to matched healthy controls.
METHODS
The PedsQL™ Gastrointestinal Symptoms Scales were completed by 64 pediatric patients with gastroparesis, 59 pediatric patients with gastroparesis-like symptoms and normal gastric emptying, and 200 age, gender, and race/ethnicity matched healthy controls. The PedsQL™ Gastrointestinal Symptoms Scales encompass 10 individual multi-item scales which measure stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea/fecal incontinence. Based on gastric emptying scintigraphy testing, those with abnormal gastric retention were classified as having gastroparesis.
RESULTS
The gastrointestinal symptoms profile analysis identified large differences between those with gastroparesis compared to healthy controls (most P <0.001), with the largest effect sizes for upper gastrointestinal symptoms including stomach pain, stomach discomfort when eating, food and drink limits, nausea, and vomiting. Those with gastroparesis self-reported similar gastrointestinal symptoms to those with normal gastric emptying, except for increased constipation.
CONCLUSIONS
Pediatric patients with gastroparesis self-reported broad multidimensional gastrointestinal symptoms profiles in comparison to healthy controls with large differences, indicating the critical need for more highly efficacious interventions to bring patient functioning within the normal range of healthy functioning.
Topics: Abdominal Pain; Child; Constipation; Gastric Emptying; Gastrointestinal Diseases; Gastroparesis; Humans; Nausea; Quality of Life; Vomiting
PubMed: 35653378
DOI: 10.1097/MPG.0000000000003484 -
Journal of Gastrointestinal and Liver... Sep 2015Disorders of gastrointestinal transit and motility are frequently found in the general population, impacting the quality of life and increasing the costs of health care... (Review)
Review
BACKGROUND AND AIMS
Disorders of gastrointestinal transit and motility are frequently found in the general population, impacting the quality of life and increasing the costs of health care services. Ultrasonographic assessment of gastric emptying is a method introduced in the early 1980s for the evaluation of dyspepsia. The aim of this paper was to assess the current role of abdominal ultrasound in the evaluation of gastric emptying.
METHOD
Using the keywords "ultrasound and gastric emptying", "echography and gastric emptying", "3D and gastric emptying" and "strain rate imaging and gastric emptying" the PubMed database was screened for publications on ultrasonography evaluating gastric emptying in adults from January 1, 2007 to December 31, 2014.
RESULTS
281 papers were identified, of which only 21 randomized studies, 18 comparative and 18 non-comparative studies met the inclusion criteria. Most studies were conducted on healthy subjects for research purposes. Thirteen studies were performed on patients with functional dyspepsia, of which 6 studies assessed treatment efficacy. Other indications for ultrasound gastric emptying evaluation were: diabetes mellitus, scleroderma, metabolic syndrome, asthma, Parkinson's disease, and obesity. Using abdominal ultrasound, delayed gastric emptying was found in 10% of patients with functional dyspepsia, 48.5% of patients with longstanding diabetes and 65-70% of patients with systemic sclerosis with a disease duration of more than 10 years.
CONCLUSION
Functional ultrasonography is a non-invasive method used for research or practical purposes that brings an insight into gastric emptying in healthy individuals, and in individuals with functional and motility gastrointestinal disorders.
Topics: Dyspepsia; Gastric Emptying; Gastroparesis; Humans; Predictive Value of Tests; Prognosis; Risk Factors; Stomach; Ultrasonography
PubMed: 26405705
DOI: 10.15403/jgld.2014.1121.243.mur -
Nuclear Medicine Communications Jan 2022We used dynamic single-photon emission computed tomography (D-SPECT) to overcome the interference of the planar dynamic imaging due to the overlap of internal organs,...
OBJECTIVE
We used dynamic single-photon emission computed tomography (D-SPECT) to overcome the interference of the planar dynamic imaging due to the overlap of internal organs, thus more accurate physiological function can be obtained.
METHODS
3D printed gastric phantom was used to simulate gastric emptying (GE). First, the planar dynamic liquid GE procedure was used and served as the reference value; second, D-SPECT followed by repeated liquid GE procedures with three gamma cameras were used. The emptying flow rate of the gastric phantom simulated three flow rates of liquid, semisolid and solid. Third, we simulated the intestinal activity that interfered with the residual value obtained by 2D dynamic imaging, which was compared with D-SPECT. Then, we brought the 3D VOI data into the postprocessing program to obtain the residual activity curve and residual percentage.
RESULTS
The residual amount obtained in the phantom at 60th minutes in the first stage is 14.57%; the residual amount of liquid emptying are Siemens: 3.33%, GE: 15.06%, PHILIPS: 1.12%; residual amount for semisolid are Siemens: 47.36%, GE: 54.25%, PHILIPS: 51.57%; residual amount for solids are Siemens: 63.98%, GE: 66.88%, PHILIPS: 63.76%. All values are within the normal range. Then, we simulated the intestinal activity that interfered with the residual value obtained by 2D dynamic imaging: 75-90 min: 10.42, 19.48, 19.51 and 11.02%; however, the residual values obtained with 3D SPECT VOI data: 75-90 min: 1.42, 1.41, 1.35 and 1.02%. These results show that the emptying data errors caused by intestinal overlap can be effectively corrected (P = 0.017).
CONCLUSION
D-SPECT imaging can overcome the interference in the semiquantitative data of residual GE caused in 2D mode.
Topics: Gastric Emptying
PubMed: 34887367
DOI: 10.1097/MNM.0000000000001486